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Abstract Introduction In the current systematic review and meta-analysis, we aim to analyze the existing literature to evaluate the role of inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) among individuals with cardiac syndrome X (CSX) compared to healthy controls. Methods We used PubMed, Web of Science, Scopus, Science Direct, and Embase to systematically search relevant publications published before April 2, 2023. We performed the meta-analysis using Stata 11.2 software (Stata Corp, College Station, TX). So, we used standardized mean difference (SMD) with a 95% confidence interval (CI) to compare the biomarker level between patients and healthy controls. The I2 and Cochran’s Q tests were adopted to determine the heterogeneity of the included studies. Results Overall, 29 articles with 3480 participants (1855 with CSX and 1625 healthy controls) were included in the analysis. There was a significantly higher level of NLR (SMD = 0.85, 95%CI = 0.55–1.15, I2 = 89.0 %), CRP (SMD = 0.69, 95%CI = 0.38 to 1.02, p

Introduction: In the current systematic review and meta-analysis, we aim to analyze the existing literature to evaluate the role of inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) among individuals with cardiac syndrome X (CSX) compared to healthy controls. Methods: We used PubMed, Web of Science, Scopus, Science Direct, and Embase to systematically search relevant publications published before April 2, 2023. We performed the meta-analysis using Stata 11.2 software (Stata Corp, College Station, TX). So, we used standardized mean difference (SMD) with a 95% confidence interval (CI) to compare the biomarker level between patients and healthy controls. The I2 and Cochran's Q tests were adopted to determine the heterogeneity of the included studies. Results: Overall, 29 articles with 3480 participants (1855 with CSX and 1625 healthy controls) were included in the analysis. There was a significantly higher level of NLR (SMD = 0.85, 95%CI = 0.55–1.15, I2 = 89.0 %), CRP (SMD = 0.69, 95%CI = 0.38 to 1.02, p < 0.0001), IL-6 (SMD = 5.70, 95%CI = 1.91 to 9.50, p = 0.003), TNF-a (SMD = 3.78, 95%CI = 0.63 to 6.92, p = 0.019), and PLR (SMD = 1.38, 95%CI = 0.50 to 2.28, p = 0.02) in the CSX group in comparison with healthy controls. Conclusion: The results of this study showed that CSX leads to a significant increase in inflammatory biomarkers, including NLR, CRP, IL-6, TNF-a, and PLR. [ABSTRACT FROM AUTHOR]

Introduction: Chronic coronary syndrome is predominantly related to the atherosclerotic obstruction of the coronary artery or arteries. However, this phenomenon is not the only causative factor in this disease. It is usually forgotten, that there is a possibility of ischemia of the cardiac muscle with no obstruction found in the main vessel. The trigger of such pathology might be underlying in the microcirculatory system and the inappropriate dilation or constriction of those small vessels, which results in insufficient blood supply to the cardiomyocytes, similarly to the typical obstructive coronary artery disease. In this article we are willing to show that such dysfunction poses a great danger to the health and life and therefore we should be able to properly diagnose and treat it. Purpose of the work: The aim of this review of up-to-date literature is to raise awareness among both doctors and patients about the phenomenon of coronary artery disease but with no significant obstruction in the vessels supplying the cardiac muscle. The common cause of such condition is coronary microvascular dysfunction, that leads to a disease called microvascular angina. Our purpose was to reveal, how dangerous to the health of the patients this could be and therefore how essential it is to provide a proper diagnose and management. In addition, we have noticed a need for a summary of what has already been discovered on this topic, available therapeutic methods and future perspectives.

Objectives: Treatment of cardiac syndrome X (CSX) remains a major challenge for conventional medicine. In this regard, developing new natural treatments could be an alternative choice. This study was planned to appraise the efficacy of chamomile-lemon balm syrup on chest pain and quality of life in patients with conventional drug-resistant CSX. Materials and Methods: 29 participants with conventional drug-resistant were enrolled in a single-arm clinical trial, and 14 participants completed the study protocol. Chamomile (Matricaria chamomilla L.)-lemon balm (Melissa officinalis L.) syrup was provided for the treatment for the 90-day study period. All conventional treatments of CSX remained unchanged. Efficacy assessment included Seattle Angina Questionnaires (SAQ), 36-item short form survey, and the Hospital Anxiety and Depression Scale (HADS). Results: An improvement was observed in the total score of all questionnaires with statistically significant changes over time of the study (P

Abstract İntroduction Patients with normal coronary arteries in whom increased vasospasm cannot be detected with the stress test should be evaluated in terms of cardiac syndrome x (CSX). İnflammatory systems are effective in endothelial activation and dysfunction in CSX. The systemic immune inflammation index (SII) is thought to be an important factor in determining the course of diseases, especially in infectious diseases or other diseases, as an indicator of the inflammation process. The aim of this study is to determine the role of SII levels in the diagnosis of CSX disease. Methods The study group included 80 patients who applied to the cardiology department of Fırat University with typical anginal complaints between October 2021 and April 2022, and were diagnosed with ischemia after the myocardial perfusion scan, and then coronary angiography was performed and normal coronary arteries were observed. Results When the study and control groups were examined according to age, gender and body mass index, hypertension, smoking, diabetes mellitus, dyslipidemia and family history, no statistical significant difference was observed between the groups. It was observed that there was a significant difference between the high sensitive C- reactive protin levels of the individuals in the study and control groups (p = 0.028). SII levels measured in samples taken from patients were significantly higher than control subjects (p = 0.003). SII cutoff at admission was 582 with 82% sensitivity and 84% specificity (area under the curve 0.972; 95% CI:0.95–0.98;p

Objectives: Treatment of cardiac syndrome X (CSX) remains a major challenge for conventional medicine. In this regard, developing new natural treatments could be an alternative choice. This study was planned to appraise the efficacy of chamomile-lemon balm syrup on chest pain and quality of life in patients with conventional drug-resistant CSX. Materials and Methods: 29 participants with conventional drug-resistant were enrolled in a single-arm clinical trial, and 14 participants completed the study protocol. Chamomile (Matricaria chamomilla L.)-lemon balm (Melissa officinalis L.) syrup was provided for the treatment for the 90-day study period. All conventional treatments of CSX remained unchanged. Efficacy assessment included Seattle Angina Questionnaires (SAQ), 36-item short form survey, and the Hospital Anxiety and Depression Scale (HADS). Results: An improvement was observed in the total score of all questionnaires with statistically significant changes over time of the study (P < 0.001). Conclusions: Chamomile-lemon balm syrup showed promising results in improving effect on angina symptoms, quality of life, and anxiety and depression in the patients with drug-resistant CSX. However, a placebo-controlled trial should be performed to verify these data. [ABSTRACT FROM AUTHOR]

İntroduction: Patients with normal coronary arteries in whom increased vasospasm cannot be detected with the stress test should be evaluated in terms of cardiac syndrome x (CSX). İnflammatory systems are effective in endothelial activation and dysfunction in CSX. The systemic immune inflammation index (SII) is thought to be an important factor in determining the course of diseases, especially in infectious diseases or other diseases, as an indicator of the inflammation process. The aim of this study is to determine the role of SII levels in the diagnosis of CSX disease. Methods: The study group included 80 patients who applied to the cardiology department of Fırat University with typical anginal complaints between October 2021 and April 2022, and were diagnosed with ischemia after the myocardial perfusion scan, and then coronary angiography was performed and normal coronary arteries were observed. Results: When the study and control groups were examined according to age, gender and body mass index, hypertension, smoking, diabetes mellitus, dyslipidemia and family history, no statistical significant difference was observed between the groups. It was observed that there was a significant difference between the high sensitive C- reactive protin levels of the individuals in the study and control groups (p = 0.028). SII levels measured in samples taken from patients were significantly higher than control subjects (p = 0.003). SII cutoff at admission was 582 with 82% sensitivity and 84% specificity (area under the curve 0.972; 95% CI:0.95–0.98;p < 0.001). Conclusion: It has been demonstrated that systemic SII parameters, which can be simply calculated with the data obtained from the complete blood count and do not require additional costs, can contribute to the prediction of CSX disease. [ABSTRACT FROM AUTHOR]

Guang-Yun Cao,1 Jian-Chao Li,1,2 Wen-Jing Wang,1 Hai-Bo Wu1 1Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, People’s Republic of China; 2HeBei North University, Zhangjiakou, Hebei Province, 050051, People’s Republic of ChinaCorrespondence: Hai-Bo Wu, Department of Cardiology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, Hebei Province, 050051, People’s Republic of China, Tel +86 15128138630, Email wuhb929@163.comObjective: This study aims to investigate the relationship between the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and cardiac syndrome X (CSX).Methods: A total of 102 patients with CSX who were hospitalized in the Cardiology Department of our hospital from December 2018 to December 2020 were enrolled in the CSX group, and 102 subjects who underwent physical examinations during the same period were included in the control group. An automatic blood cell analyzer was adopted to detect the neutrophil count (NC), lymphocyte count (LC), and number of platelets (PLT) in the whole blood of the subjects in both groups, and the NLR and PLR were calculated. Electrocardiography was conducted on the subjects in both groups to detect whether any abnormality existed in the ST segment. The receiver operating curve (ROC) was used to evaluate the diagnostic value of each indicator of CSX, and multivariate logistic regression analysis was adopted for the analysis of the influencing factors.Results: No significant differences existed in age, gender, smoking history, or family history of diabetes mellitus, hypertension, and tumors between the two groups (p > 0.05). When compared with the control group, the NC, PLT, NLR, PLR, and rate of abnormality of the ST segment on the electrocardiogram were significantly higher, and the LC was significantly lower in the CSX group (p < 0.05). Multivariate logistic regression analysis showed that the ST-segment abnormality (3.95 [2.10∼ 7.41]; NLR > 2.21, 3.46 [1.87∼ 6.39]; and PLR > 119.77, 3.66 [1.99∼ 6.73]) was a correlated risk factor for the occurrence of CSX (p < 0.05).Conclusion: Both the NLR and PLR in patients with CSX were significantly elevated, and both have a certain predictive value for the occurrence of CSX and are expected to be effective biomarkers for CSX.Keywords: cardiac syndrome X, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, correlation analysis, inflammation

Objective: The pathogenesis of elevated uric acid (UA) levels in patients with cardiac syndrome X (CSX) is unclear, and the results presented in recent papers on UA levels in patients with CSX are controversial. Therefore, we conducted a meta-analysis to assess the relationship between UA levels and CSX. Methods: Three databases, including the Web of Science, EMBASE and PubMed, were systematically searched until January 2022. Fixed-effect and random-effects models were used to analyze the relationship between UA levels and CSX. Subgroup analysis and sensitivity analysis were also performed. Results: Six studies involving 406 CSX patients and 267 non-CSX were included. Our results showed a significant relationship between UA levels and CSX, with a pooled SMD of 0.68 (95% CI 0.37 to 1.00; p < 0.0001). We also found a close relationship between UA levels and CSX for patients ≥ 55 years old (SMD:0.70, 95% CI: 0.41 to 0.99, p < 0.00001), for patients < 55 years old (SMD: 0.68, 95% CI: 0.25 to 1.12, p =0 .002), for women ≥ 60% (SMD: 0.77, 95% CI: 0.33 to 1.14, p =0 .0004), for women < 60% (SMD: 0.61, 95% CI:0.23 to 0.98, p =0 .001), for BMI ≥ 28 Kg/m² (SMD :0.61, 95% CI: 0.23 to 0.98, p =0 .001), for BMI < 28 Kg/m² (SMD: 0.75, 95% CI: 0.31 to 1.19, p =0 .0009), for publication years ≥ 2012 (SMD :0.69, 95% CI: 0.23 to 1.15, p = 0.003), for publication years < 2012 (SMD: 0.73, 95% CI:0.41 to 1.05, p < 0.00001), and for Turkey (SMD :0.75, 95% CI:0.38 to 1.11, p <.0001). Sensitivity analysis showed that the pooled results remained consistent after removing any one study or converting the random-effects model to fixed-effects model. Conclusion: Our results indicated a strong association between high UA levels and CSX. However, more well-designed studies are needed to investigate whether early treatment of hyperuricemia can reduce the incidence of CSX. [ABSTRACT FROM AUTHOR]

The systemic immune inflammation index (SII; platelet count x neutrophil-lymphocyte ratio), a new marker, predicts adverse clinical outcomes in many conditions, including acute and chronic coronary syndromes, pulmonary embolism, cancers, and contrast nephropathy. The aim of this study was to determine the relationship between SII and microvascular dysfunction in patients with Cardiac Syndrome X (CSX); 105 patients with CSX and 105 patients with normal coronary arteries were included. Microvascular dysfunction was determined angiographically using myocardial blush grade (MBG) and total myocardial blush score (TMBS). We observed that the SII levels were higher in the CSX (+) group (687 [355–2211] vs 418 [198–1614], P <.001). The SII levels were also found to be significant independent predictors for CSX in multiple regression analysis (P =.001). SII levels >440 had 83.8% sensitivity and 55.2% specificity (area under the curve [AUC]:.923, 95% CI:.895–.999, P <.001) for predicting CSX. There is a significant correlation between SII levels and CSX. [ABSTRACT FROM AUTHOR]

No hemodynamically significant atherosclerotic plaques are observed in up to 30% of patients reporting angina and undergoing coronary angiography. To investigate risk factors associated with non-obstructive coronary artery disease (NOCAD), we analyzed the medical records of, consecutively, 136 NOCAD subjects and 128 patients with significant stenosis in at least one coronary artery (the OCAD group). The blood concentrations of the TC (4.40 [3.78–5.63] mmol/L vs. 4.12 [3.42–5.01] mmol/L; p = 0.026), LDL-C (2.32 [1.80–3.50] mmol/L vs. 2.10 [1.50–2.70] mmol/L; p = 0.003), non-HDL-C (2.89 [2.29–4.19] mmol/L vs. 2.66 [2.06–3.39] mmol/L; p = 0.045), as well as the LDL-C/HDL-C ratio (1.75 [1.22–2.60] vs. 1.50 [1.10–1.95]; p = 0.018) were significantly increased in the NOCAD patients compared to the OCAD group due to the lower prevalence and intensity of the statin therapy in the NOCAD individuals (p < 0.001). Moreover, the abovementioned lipid parameters appeared to be valuable predictors of NOCAD, with the LDL-C (OR = 1.44; 95%CI = 1.14–1.82) and LDL-C/HDL-C (OR = 1.51; 95%CI = 1.13–2.02) showing the highest odds ratios. Furthermore, multivariable logistic regression models determined female sex as the independent risk factor for NOCAD (OR = 2.37; 95%CI = 1.33–4.20). Simultaneously, arterial hypertension substantially lowered the probability of NOCAD (OR = 0.21; 95%CI = 0.10–0.43). To conclude, female sex, the absence of arterial hypertension, as well as increased TC, LDL-C, non-HDL, and LDL-C/HDL-C ratio are risk factors for NOCAD in patients reporting angina, potentially as a result of poor hypercholesterolemia management. [ABSTRACT FROM AUTHOR]

PurposeCardiac syndrome X (CSX) is a condition with normal coronary angiography but angina pectoris. Chronic inflammation caused by Helicobacter pylori (H. pylori) infection may play a pathogenic role in CSX. Therefore, we conducted a meta-analysis to explore the relationship between H. pylori infection and risk of CSX.MethodsA systematic search in the Web of Science, Medline, Embase and Chinese databases (CNKI and Wanfang) was conducted up to October 2021. Articles on the association between H. pylori infection and the risk of CSX were included and were analyzed by R software (version 4.1.0).ResultsTen case-control studies involving 703 CSX patients and 731 healthy controls were included. H. pylori infection was associated with an increased risk of CSX (OR: 8.29, 95% CI: 4.64–14.82). We also found a significant association in those 25–40 years of age (OR: 1.34, 95% CI: 1.04–1.72), those 40–50 years of age (OR: 11.27, 95% CI: 4.29–29.61), those over 50 years of age (OR: 7.18, 95% CI: 3.59–14.36), those in developing countries [Iran (OR: 12.99, 95% CI: 8.61–19.60) and China (OR: 5.14, 95% CI: 3.09–8.56)]. However, this association was not apparent in a developed country [Italy (OR: 0.93, 95% CI: 0.37–2.33)].ConclusionsOur study suggested a possible association between H. pylori infection and the risk of CSX. Its pathogenicity is stronger in middle-aged individuals and some developing countries. However, more studies are needed to further investigate whether early eradication of H. pylori can reduce the incidence rate of CSX, especially in middle-aged individuals and some developing countries.

OBJECTIVE: Cardiac syndrome X (CSX) is typically described with ischemia in stress tests in addition to angina-like chest pain and without stenosis in coronary angiography. We aimed at determining the relationship between LMR and CSX. PATIENTS AND METHODS: We retrospectively collected patients with CSX between January 2016 and December 2019. Patients with typical angina-like chest pain, normal 12-lead electrocardiography at rest, a positive response to the exercise test (> 0.1 mV ST-segment depression at 80 ms after the J point in two or more contiguous leads) or ischemia on myocardial perfusion scintigraphy and normal coronary angiography were included in the study as CSX patients. RESULTS: This study consisted of 116 patients with CSX and 153 control groups. The mean age of the patients with CSX was 52.7±9.7 years, and the mean age of the control group was 53.7±10.6 years (p= 0.416). The patients with CSX were more likely to have higher monocyte counts and LMR. According to the Pearson correlation test, the CRP value negatively correlated with the LMR. In multivariate logistic regression analysis, LMR remained a significant predictor of CSX. In ROC analysis, LMR < 4.1 had 64% sensitivity and 50% specificity (ROC area under curve: 0.587, 95% CI: 0.519-0.655, p=0.015) in accurately predicting a CSX diagnosis. CONCLUSIONS: We showed that lower LMR levels were associated with the presence of CSX. [ABSTRACT FROM AUTHOR]

Background: Patients with chest pain may have normal coronary arteries and suffer from microvascular angina (MVA). The aim of this study was to determine if patients with suspected MVA have lower global myocardial perfusion (global MP) during adenosine stress compared with healthy controls and coronary artery disease (CAD) patients and to determine if there are sex differences in global MP. Methods: Twenty‐three patients with suspected MVA (66 ± 11 years), 19 CAD patients (69 ± 5 years) with stress‐induced ischaemia and 24 healthy controls (61 ± 10 years) underwent cardiac magnetic resonance (CMR) including coronary sinus flow measurements and first‐pass perfusion at rest and during adenosine stress. Global MP was quantified as coronary sinus flow normalized to left ventricular mass. Results: Global perfusion was lower during stress in patients with suspected MVA (2.9 ± 1.0 ml/min/g) compared with healthy volunteers (3.7 ± 1.1 ml/min/g, p = 0.018), but higher compared with CAD patients (2.0 ± 0.9 ml/min/g, p = 0.019). Female controls had higher global MP than male controls both at rest (1.0 ± 0.3 vs. 0.7 ± 0.2 ml/min/g, p = 0.003) and during stress (4.4 ± 1.0 vs. 3.1 ± 0.6 ml/min/g, p = 0.001). Furthermore, females with suspected MVA showed higher global MP than males with suspected MVA (3.3 ± 1.0 vs. 2.4 ± 0.7, p = 0.04). Conclusions: Patients with suspected MVA have lower global MP at stress than healthy volunteers but higher than patients with CAD. Furthermore, there seems to be a sex difference in global MP at stress both in healthy volunteers and in patients with suspected MVA, with higher global MP in females, which implies a need for sex‐specific normal limits when assessing quantitative MP. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of this study was to assess the nature of myocardial dysfunction in the cardiac syndrome X (CSX) and insignificant coronary artery disease (ICAD) using dobutamine stress echocardiography (DSE) and coronary calcium scoring (CAC). Methods: We prospectively studied 35 consecutive patients who complained of exertional angina, had ≥1 mm ST shift on exercise stress test but normal or no obstructive CAD (<50%) on angiography. Patients were divided into CSX (n = 27) with normal arteries and ICAD (n = 8) with insignificant stenosis. Results: CSX patients had more females, lower calcium score and less prevalent cardiac risk factors compared to ICAD (p < 0.05 for all). At peak stress, MAPSE and TAPSE failed to increase in both groups. LV septal and lateral s' increased in the two groups but the increment increase was less in CSX than ICAD (p < 0.05) while other diastolic indices did not differ between groups (p > 0.05 for all). CAC correlated modestly with LV and RV systolic velocities: septal s' (r = −0.65, p < 0.001) lateral s' (r = −0.35, p = 0.04) and right s' (r = −0.53, p = 0.005) in CSX, while in ICAD patients only with RV s' (r = −0.58, p = 0.02). On multivariate model, only septal s' OR 1.816 (1.1090–3.820, p = 0.04) proved the most powerful independent predictor of CAC. Conclusions: Compromised LV longitudinal systolic velocities were more pronounced and calcium score as a surrogate for atherosclerosis was lower in CSX than ICAD. These findings strengthen the evidence for different pathogenesis of CSX compared to ICAD, with microvascular disease in the former and calcification in the latter. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although the underlying mechanism is not yet fully understood, Cardiac Syndrome X (CSX) is defined as microvascular dysfunction. Prolidase plays a role in collagen synthesis. Increased serum prolidase activity (SPA) has been shown to correlate with collagen turnover. Augmented collagen turn-over may be associated with vascular fibrosis and microvascular dysfunction. In this study, we assessed whether there was a correlation between CXS and prolidase activity. METHODS: This case-control study included 45 consecutive CSX patients (mean age 50.7+-6.5 years, 27 women) and 40 healthy controls (mean age 51.2+-6.5 years, 25 women). Prolidase activity was determined with the Human Xaa-Pro Dipeptidase/Prolidase enzyme-linked immunosorbent assay kit (Cusabio Biotech Co. Ltd, China). RESULTS: Mean prolidase activity was 898.8+-639.1 mU/mL in the CSX group and 434.1+-289.8 mU/mL in the control group (p

Microvascular angina (MVA) is a condition characterized by the presence of angina-like chest pain, a positive response to exercise stress tests, and no significant stenosis of coronary arteries in coronary angiography, with absence of any other specific cardiac diseases. The etiology of this syndrome is still not known and it is probably multifactorial. Coronary microvascular dysfunction is proposed as the main pathophysiological mechanism in the development of MVA. Altered somatic and visceral pain perception and autonomic imbalance, in addition to myocardial ischemia, has been observed in subjects with MVA, involving dynamic variations in the vasomotor tone of coronary microcirculation with consequent transient ischemic episodes. Other theories suggest that MVA may be a result of a chronic inflammatory state in the body that can negatively influence the endothelium or a local imbalance of factors regulating its function. This article presents the latest information about the epidemiology, diagnostics, etiopathogenesis, prognosis, and treatment of patients with MVA. [ABSTRACT FROM AUTHOR]

Objective: Although chest pain and normal coronary arteries (known as cardiac syndrome X [CSX]) remained a prevalent clinical condition, underlying pathogenesis has not been fully explained. Microvascular dysfunction has been considered as the most likely cause of CSX. In this research, we attempted to evaluate the coronary sinus filling time (CSFT) at angiographic films, and also introducing it as a new indicator for microvascular function. Patients and Methodology: Patients with typical angina or abnormal chest pain with stress-induced ischemia in prior stress tests formed angina group and control group consisted of patients with severe mitral stenosis underwent coronary artery angiography before the balloon mitral valvuloplasty. CSFT was explained as the time necessary for the contrast with pass through myocardial capillaries and reach to the coronary sinus origin at coronary angiography. Furthermore, thrombolysis in myocardial infarction (TIMI), frame count, and myocardial blush score were evaluated for each group. At the end, we compared these parameters and reported the results. Results: The angina group consisted of 128 patients and there were 71 patients in the control group. The mean of the CSFT in angina group was 47.2 ± 9.9 (in frame count), which was greater than the mean of the control group (mean: 32.2 ± 3, P = 0.0001). Corrected TIMI frame count was 21.1 ± 3.4 in angina group and 20.1 ± 3.1 in the control group, and the differences were not statistically significant (P = 0.75). Myocardial blush score in the angina and the control group had not indicate any meaningful difference (P = 0.52). Conclusion: CSFT in contrast with TIMI frame count and myocardial blush score, was significantly prolonged in patients with angina and normal coronary arteries.

The aim of this work was to define the notion of cardiac syndrome X based on latest research, determine its connection with mental disturbances and present the current therapeutic directions. Cardiac syndrome X was distinguished in 1973 to describe a group of patients with coronary syndrome symptoms despite normal coronary vessels in coronarography. Many years have passed since then, but the syndrome definition and the diagnostic criteria still arouse controversy. It is estimated that 10 to 20% of persons who undergo coronarography suffer from cardiac syndrome X, a vast majority of them being perimenopausal women. That patient population suffers from anxiety disorders, depressive symptoms and sleep disturbances much more frequently than does general population. Treatment includes a range of medicines with various mechanisms of action, but their effectiveness is limited; non-pharmacological actions are a significant part of the therapy. The patient group with cardiac syndrome X requires periodic follow-ups because prospective observation has shown that it is a risk group concerning development of atherosclerosis and acute coronary syndrome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac syndrome X (CSX) has been associated with endothelial dysfunction and inflammation. We conducted a case-control study to evaluate the association between platelet and endothelial-derived microparticles (PMPs and EMPs), as specific quantitative plasma markers of endothelial dysfunction, and the presence of CSX. METHODS: The present study was conducted on 40 CSX patients and 19 healthy individuals. C-reactive protein (CRP), and hematological and biochemical parameters were evaluated. The MP concentration in platelet-poor plasma (PPP) was quantitatively determined through flow cytometry using specific anti-human CD31, CD41a, CD62E, and CD144 antibodies. RESULTS: The mean platelet volume (MPV) and positive CRP rate (≥ 3.8 mg/l) were higher in patients compared to controls (P = 0.020 and P = 0.010, respectively). The CD62E+, CD144+, and CD31+41− EMPs, as well as CD41+ and CD31+CD41+ PMPs showed significant increase in CSX patients compared to controls (P < 0.050). There were direct correlations between the mean percentage of detected EMPs and PMPs as well as between their expression intensity; however, a reverse correlation was seen between the percentage of MPs and CD144 and CD41. Moreover, the MP level was reversely associated with prothrombin time (PT) and partial thromboplastin time (PTT) values. Only CD31+CD41+ PMP was correlated with CRP. CONCLUSION: It seems that EMPs and PMPs increase in CSX, which may contribute to various processes involved in the development of this syndrome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the myocardial energy expenditure (MEE) in patients with cardiac syndrome X (CSX) and to examine its association with exercise electrocardiogram (ECG) parameters. Methods: A total of 99 patients who underwent coronary angiography and who were diagnosed as having normal coronary arteries were included. The patients were divided into 2 groups based on symptoms and exercise ECG parameters: 56 CSX patients and 43 control patients with a negative stress test. MEE was calculated using transthoracic echocardiography-derived parameters: circumferential end-systolic stress, left ventricular ejection time, and stroke volume. Results: In patients with CSX, the MEE at rest was 28% higher in than the control group (89.2+-36.3 vs. 69.8+-17.2 cal/minute). Correlation analysis revealed a moderately negative correlation between MEE and the Duke treadmill score (DTS) (β: -0.456; p

OBJECTIVE: Although the underlying mechanism is not yet fully understood, Cardiac Syndrome X (CSX) is defined as microvascular dysfunction. Prolidase plays a role in collagen synthesis. Increased serum prolidase activity (SPA) has been shown to correlate with collagen turnover. Augmented collagen turn-over may be associated with vascular fibrosis and microvascular dysfunction. In this study, we assessed whether there was a correlation between CXS and prolidase activity. METHODS: This case-control study included 45 consecutive CSX patients (mean age 50.7±6.5 years, 27 women) and 40 healthy controls (mean age 51.2±6.5 years, 25 women). Prolidase activity was determined with the Human Xaa-Pro Dipeptidase/Prolidase enzyme-linked immunosorbent assay kit (Cusabio Biotech Co. Ltd, China). RESULTS: Mean prolidase activity was 898.8±639.1 mU/mL in the CSX group and 434.1±289.8 mU/mL in the control group (p<0.001). In ROC analysis, it was found that the SPA value above 350 mU/mL sympathizes with the diagnosis of CSX. CONCLUSION: Increased SPA in CXS patients may play an essential role in the pathophysiology of CSX, leading to augmented oxidative stress and vascular fibrosis, endothelial dysfunction, and increased microvascular resistance. [ABSTRACT FROM AUTHOR]

• Cardiac syndrome X (CSX) patients have impaired coronary flow velocity reserve (CFVR). • Left ventricular global longitudinal strain (LVGLS) values are reduced at rest and during exercise in CSX patients. • CFVR and LVGLS are more profoundly impaired in CSX subgroup with slow coronary flow (SCF). • Presence of SCF in CSX patients also reflects worse clinical presentation. • Findings might contribute to further risk stratification of this population. Microvascular dysfunction (MVD) is associated with adverse prognosis and may account for abnormal stress tests and angina symptoms in women with cardiac syndrome X (CSX). The aim of our study was to assess MVD by coronary flow velocity reserve (CFVR) and left ventricular (LV) contractile function by LV global longitudinal strain (LVGLS) in CSX patients with respect to presence of slow coronary flow (SCF). It was of additional importance to evaluate clinical status of CSX patients using Seattle Angina Questionnaire. Study population included 70 women with CSX (mean age 61 ± 7 years) and 34 age-matched controls. CSX group was stratified into two subgroups depending on SCF presence: CSX-Thrombolysis In Myocardial Infarction (TIMI) 3- normal flow subgroup (n = 38) and CSX-TIMI 2- SCF subgroup (n = 32) as defined by coronary angiography. LVGLS measurements and CFVR of left anterior descending (LAD) and posterior descending (PD) artery were performed. CFVR-LAD and PD were markedly impaired in CSX group compared to controls (2.34 ± 0.25 vs 3.05 ± 0.21, p < 0.001; 2.32 ± 0.24 vs 3.01 ± 0.13, p < 0.001), and furthermore decreased in CSX-TIMI 2 patients. Resting, peak, and ΔLVGLS were all significantly impaired in CSX group compared to controls (for all p < 0.001), and furthermore reduced in CSX-TIMI 2 subgroup. Strongest correlation was found between peak LVGLS and CFVR LAD (r = −0.784, p < 0.001) and PD (r = −0.772, p < 0.001). CSX-TIMI 2 subgroup had more frequent angina symptoms and more impaired quality of life. MVD in CSX patients is demonstrated by reduction in CFVR and LVGLS values. SCF implies more profound impairment of microvascular and LV systolic function along with worse clinical presentation. [ABSTRACT FROM AUTHOR]

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Objective: Few studies have investigated haem oxygenase-1 gene (HMOX1) promoter polymorphism in microvascular angina (MVA). Materials and methods: HMOX1 promoter (GT)n repeats were examined in healthy controls (N = 220) and MVA subjects (N = 181). Results: The distribution of genotype of SS, SL and LL were significantly different in MVA (17%, 51%, 33%) vs. normal controls (35%, 46%, 20%) (p < 0.001, S allele: ≤30 repeats, L allele: >30 repeats). In multivariate analysis, carrier of L allele (odds ratio 2.772, p < 0.001) was a significant predictor for the diagnosis of MVA. Conclusions: Subjects with MVA had longer HMOX1 promoter (GT)n repeats than the healthy controls. Trial registration number: NCT01198730 at [ABSTRACT FROM AUTHOR]

Objectives: We planned to assess the right ventricular mechanics in subjects with typical chest pain and angiographically normal coronary arteries (microvascular angina [MVA]) and to search for an association between right ventricular mechanics, coronary flow reserve, and exercise tolerance. Methods: Seventy‐one patients with MVA (mean age of 48.5 ± 7.9 years, 63% female) and 30 healthy control subjects were recruited. Right ventricular mechanics were calculated utilizing speckle tracking imaging. The exercise capacity was assessed by metabolic equivalents (METs). Coronary flow reserve (CFR) was calculated as the ratio between hyperemic (in response to intravenous adenosine) diastolic peak flow velocity and the basal diastolic peak velocity. Results: Coronary flow reserve (a surrogate marker of microvascular dysfunction) was diminished in MVA patients compared with the control group (2.41 ± 0.35 vs 3.35 ± 0.5; P <.03). Patients with lower right ventricular global longitudinal strain (RVGLS) and right ventricular global longitudinal strain rate (RVGLSr) had a considerably lower CFR (P <.001) and a significantly lower MET (P <.001) than patients with normal RV mechanics. Right ventricular global longitudinal strain and RVGLSr were significantly correlated with both CFR and METs in subjects with MVA. Receiver operating characteristic (ROC) curve analysis demonstrated that RVGLS ≤ −14.5 was the best cutoff value for the prediction of impaired exercise tolerance in patients with MVA. Conclusion: We suggested that impaired right ventricular mechanics in subjects with microvascular angina was associated with reduced exercise capacity. Moreover, right ventricular mechanics is significantly correlated with coronary flow reserve. Henceforth, right ventricular mechanics might be of value for both risk stratification and follow‐up in cases with microvascular dysfunction. [ABSTRACT FROM AUTHOR]

Our clinical case shows patient with worsening clinical signs of angina without obstructive lesions of coronary artery which requires further control. Recommendations for lifestyle modification as well as further treatment tactics are described. This case is іnterestіng іn the development of decompensatіon (oedema of the lower extremities, reduced tolerance to stress) in a patient with cardiac syndrome X. Management of patents with angina and evidence of myocardial schema on stress testing without obstructive coronary artery disease by angiography (previously referred to as cardiac syndrome X, or CSX) is a challenge. Key points for the clіnіcіan include recognition of schema and deployment of guideline-endorsed therapy for angina and reduction of cardiac risk factors. Systemic hypertension is often associated with mіcrovascular angіna. Several pathogenic mechanisms have been іdentіfіed which represent suitable targets for treatment. Mіcrovascular dysfunction needs to be іnvestіgated (and treated if present) іn patents with systemic hypertension, angina and angіographically normal coronary arteries.

Literature reveals two kinds of menstruation-related anginas-cardiac syndrome X (CSX) and catamenial angina. CSX generally occurs in perimenopausal or postmenopausal women; catamenial angina affects females from puberty to menopause with existing/preexisting or predisposed to coronary artery disease. CSX involves recurring anginal-type retrosternal chest pains during exercise or rest with no significant findings on angiogram. Catamenial angina is menstruation-associated recurrent nonexertional left-sided chest pain alongside diaphoresis, hot flushes, and persistent lethargy. Pathophysiology of both anginas revolve around decreased levels of estrogen. Estrogen is known to act via genomic and nongenomic pathways on cardiomyocytes, endothelial cells, and smooth muscle cells to exert its cardioprotective effect. These cardioprotective effects could be lost during the postovulation phase and at the end of menstruation as well as during perimenopause or menopause owing to the decreased levels of estrogen. Evaluation should begin with a history and physical examination and focus on noninvasive tests such as exercise tolerance test, electrocardiogram, and echocardiogram. Reducing symptoms that cause discomfort and improving quality of life should be the main goal in management. Nitrates along with β blockers and analgesics for pain are the main pharmacologic modalities. Exercise training, smoking cessation, weight loss, and dietary changes are nonpharmacological modalities. Proper awareness and effective communication with patients or caregivers can lead to early diagnosis and treatment initiation., Competing Interests: Conflict of Interest None declared., (International College of Angiology. This article is published by Thieme.)

Objective: Cardiac Syndrome X (CSX) can be defined as having chest pain with angina in patients with normal coronary arteries. Endothelial and microvascular dysfunction is responsible from pathophysiology of the inflammatory CSX disease. Inflammation is an important factor for progression of especially ischemic heart diseases. It is accepted that both number of B and T lymphocytes and expression of various proinflammatory cytokines that are released from those cells increase during inflammatory response. Different proinflammatory cytokines are produced by activated mcrophages and T lymphocytes. Since interleukin-17 (IL-17) induces many signaling molecules, which promote immune response and have role in inflammation, it is assumed that IL-17 can play a role in pathogenesis of CSX. In our study, the relation of CSX with IL-17 serum levels and - 152G/A polymorphism on IL-17 gene was investigated. Methods: Serum IL-17 levels of blood samples from 100 CSX patients and 101 healthy control individuals by using ELISA method. After DNA isolation was performed from blood samples, IL-17 gene -152G/A polymorphisms were detected based on PCR-RFLP method for both patients and healthy individuals. Promotor region of IL-17 gene was amplified by PCR method and then, genotyping was performed by using PCR products for RFLP step. After that, obtained data for CSX patients and healthy control group were compared by statistical analysis. Results: When IL-17 gene -152G/A polymorphism genotyping results of CSX patients and healthy control individuals were compared, no statistically significant difference was observed in both genotypic and allelic distributions (p=0.218). IL-17 serum levels were found as statistically significantly higher in CSX patients than healthy controls (p<0.001). Conclusion: Endothelium has significant role in regulation of vascular functions. Inflammatory response is generated against endothelial activation in the pathogenesis of CSX. Increase in CRP levels, which is a marker of inflammation, is a common for both coronary artery disease and CSX, associated with endothelial dysfunction. Helper T cells take important parts in cardiovascular diseases. IL-17 induces expression of different proinflammatory cytokines and chemokines, participating in tissue infiltration and destruction. There are also several studies that prove the significant role of proinflammatory IL-17, which is released from T cells, in cardiovascular diseases, supporting our results. Besides, it has been demonstrated that statins, having anti-inflammatory effects, inhibit IL-17 gene expression and cytokine release. In this context, we foresee that statins can have a subsidiary effect on CSX treatment to suppress inflammatory response in patients, of which IL-17 levels were determined as significantly higher than healthy controls. [ABSTRACT FROM AUTHOR]

Endothelial and microvascular dysfunction serve important roles in the formation and pathogenesis of cardiac syndrome X (CSX). Expression of receptor for advanced glycation end products (RAGE) is suggested to be increased in several conditions, including diabetes, inflammation and vascular diseases. In the present study, RAGE gene polymorphisms in patients with CSX and healthy controls were investigated. A total of 114 patients, diagnosed with CSX using coronary angiography results following complaints of angina and objective ischemia, and 103 healthy controls participated in the study. Whether there was a difference in genotype distributions of RAGE gene -374T/A, -429T/C and Glys82Ser polymorphisms between patients with CSX and healthy controls was investigated. Following DNA isolation from blood samples of the participants, the polymorphic regions were examined by quantitative polymerase chain reaction, and the genotyping results were statistically analyzed. When the genotypic distributions of -374T/A, -429T/C and Gly82Ser polymorphisms were investigated in patients with CSX and healthy controls, no statistically significant differences were identified between the two groups (P>0.05). Likewise, no statistically significant differences were observed in the allelic distributions of all 3 polymorphic regions (P>0.05). To the best of our knowledge, the present study also investigated the association between CSX and RAGE gene polymorphisms for the first time. No statistically significant differences in RAGE gene polymorphisms between the CSX and control groups were observed. We hypothesized that significant results may be obtained by increasing the numbers of patients and healthy controls in future studies. [ABSTRACT FROM AUTHOR]

Aim: Cardiac Syndrome X patient population is defined as typical angina with detected ischemia in non-invasive tests and normal epicardial coronary arteries in coronary angiography. The increase in CRP levels and other inflammatory markers in CSX patients indicates that the disease has an inflammatory pathogenesis. CYP2J2, a cytochrome P450 enzyme, is expressed in high amounts in the coronary artery endothelium, smooth muscle cells and cardiomyocytes. The main role of CYP2J2 is derivation of arachidonic acid into 4 different types of epoxyeicosatrieonic acids (EET), which are 5,6-, 8,9-, 11,12-14,15-. These EETs inhibit formation of the inflammatory response by decreasing endothelial expression of TNF-a induced VCAM-1 and reduce the adhesion of leukocytes to vascular endothelium by inhibiting NF-κB. CYP2J2 gene -76G>T polymorphism causes a decrease in expression of CYP2J2 and its metabolites. In this study, we aimed to investigate the relationship between CSX, in whose pathophysiology inflammation is thought to play a role and CYP2J2 gene -76G>T polymorphism, which is known to be involved in inflammatory response. Material and Method: We compared consecutive 125 CSX patients and 125 healthy individuals in terms of CYP2J2 gene -76G>T polymorphism. The genotyping of the polymorphism was applied by using real time-PCR method. Results: There was no statistically significant difference between the patients and the control when TT, GT and GG genotypes were analyzed (p>0,05). Conclusion: It is suggested that CYP2J2 -76G>T polymorphism does not play an important role in the pathogenesis of CSX. [ABSTRACT FROM AUTHOR]

Aim: Even though it is well known that major adverse cardiac event rates elevate in cardiac syndrome X (CSX) patients, it is not clearly known whether the risk of atrial fibrillation (AF) and ventricular arrhythmia (VA) is elevated or not. The purpose of this study was to evaluate AF and VA risks. Therefore, P wave dispersion (PWD), an indicator of development of AF; and corrected QT interval dispersion (CQTD), Tp-e interval, Tp-e interval/corrected QT ratio, which demonstrate the risk of development of VA, were assessed in CSX patients. Methods: The study was realized as a retrospective trial. A total of 298 subjects (155 CSX patients, 143 controls) were examined. PWD, CQTD, Tp-e interval, Tp-e interval/corrected QT ratio were calculated and compared between both groups. Results: PWD, CQTD, Tp-e interval, Tp-e interval/corrected QT ratio values were elevated in CSX patients compared to the healthy subjects (p=0.003, p<0.001, p<0.001 and p<0.001 respectively). Conclusion: Based on these outcomes it may be thought that CSX patients have increased atrial and ventricular repolarization abnormalities compared to normal population. Furthermore, our results may indirectly indicate that patients with CSX have increased risk of AF and VA. [ABSTRACT FROM AUTHOR]

Objective: Cardiac syndrome X (CSX) is defined as angina-like symptoms, abnormalities on stress testing, and normal epicardial coronary arteries on coronary angiography. The aim of this study was to determine the Hospital Anxiety and Depression scores of patients with CSX and to compare with healthy controls. Materials/Subjects and Methods: Patients undergoing coronary angiography between January 2015 and December 2016 because of clinical indications, including abnormal noninvasive test results were examined. Two hundred and 10 subjects (110 patients with CSX, 100 controls) were enrolled. Demographic characteristics including age, education level, marriage status, and history of stressful life events were recorded. The Turkish version of the Hospital Anxiety and Depression scale was evaluated in the study population.Results: Anxiety, depression, and total scores in the patients with CSX were significantly higher than those in the control group (p < 0.001, p < 0.003, p < 0.001, respectively). Among women, anxiety, depression, total scores, and stressful life events were significantly higher in the CSX group (p = 0.006, p = 0.015, p = 0.001, p < 0.001, respectively). Patients with lower educational status had higher anxiety scores (p = 0.03), stressful life events, and HAD-A > 10 were the only independent predictors of CSX in logistic regression analysis with comparable ORs 2.256 (95% CI 1.057-4.817, p = 0.03) and 2,399 (95% CI 1.248-4.613, p = 0.009) respectively.Conclusion: The results of our research suggest that patients with CSX have a high prevalence of stress and psychiatric disturbances. Interventions targeted toward improving the quality of life and to give psychological support may have the potential benefits especially for women and individuals with lower education. [ABSTRACT FROM AUTHOR]

Background. Recent studies have suggested that angiogenic factors may affect vascular endothelial integrity. On the other hand, endothelial dysfunction is the main pathological mechanism in microvascular angina (MVA) or cardiac syndrome X. Therefore, we aimed to determine the levels of angiogenic factors in MVA patients. In addition, we investigated the effects of metoprolol, as a beta blocker agent, on the serum levels of these factors. Methods. Thirty patients with MVA (17 female/13 male; mean age: 55.53±9.18 years) and twenty healthy controls (14 female/6 male; mean age: 51.40±9.16 years) were enrolled. The serum amounts of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and tyrosine kinase-2 receptor (Tie-2) were measured in healthy controls, MVA patients at baseline and after metoprolol therapy (25 mg for one month) by enzyme-linked immunosorbent assay. Results. The levels of Ang-2 and Tie-2 were significantly higher in MVA patients at baseline in comparison with controls (Ang-2: 277.02±186.08 vs.164.46±49.83 ng/l, P=0.011; Tie-2: 28.97±18.85 vs. 14.90±4.05 ng/ml, P=0.002; respectively). But this difference in the Ang-1 levels was not significant (P=0.829). Additionally, the levels of angiogenic factors in MVA patients after metoprolol therapy were not significantly changed in comparison with the baseline status (P>0.05). Conclusion. Our results considered a possible role for angiogenic factors in the pathophysiology of MVA, which need further investigation for elucidation. In addition, this study has not showed an effective role for metoprolol in changing the angiogenic factors levels as a therapeutic agent in MVA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac syndrome X (CSX) has been associated with endothelial dysfunction and inflammation. We conducted a case-control study to evaluate the association between platelet‎ and endothelial-derived microparticles (PMPs and EMPs), as specific quantitative plasma markers of endothelial dysfunction, and the presence of CSX.METHODS: The present study was conducted on 40 CSX patients and 19 healthy individuals. C-reactive protein (CRP), and hematological and biochemical parameters were evaluated. The MP concentration in platelet-poor plasma (PPP) was quantitatively determined through flow cytometry using specific anti-human CD31, CD41a, CD62E, and CD144antibodies.RESULTS: The mean platelet volume (MPV) and positive CRP rate (≥ 3.8 mg/l) were higher in patients compared to controls (P = 0.020 and P = 0.010, respectively). The CD62E+, CD144+, and CD31+41− EMPs, as well as CD41+ and CD31+CD41+ PMPs showed significant increase in CSX patients compared to controls (P < 0.050). There were direct correlations between the mean percentage of detected EMPs and PMPs as well as between their expression intensity; however, a reverse correlation was seen between the percentage of MPs and CD144and CD41. Moreover, the MP level was reversely associated with prothrombin time (PT) and partial thromboplastin time (PTT) values. Only CD31+CD41+ PMP was correlated with CRP.CONCLUSION: It seems that EMPs and PMPs increase in CSX, which may contribute to various processes involved in the development of this syndrome.

Background: Cardiac syndrome X includes a heterogenous group of patients with angina but normal epicardial coronaries in angiography. Objective: Our objective was to study the clinical characteristics of patients with cardiac syndrome X. Methods: Data of patients who underwent coronary angiography over a period of one year was retrospectively analyzed. Those with normal or non-obstructive coronaries in angiography with chest pain were included in this study. Results: 1203 patients underwent coronary angiography during the study period. 105 (8.7%) patients fulfilled the inclusion criteria. There were 52 (49.5%) males and 53 (50.5%) females including 31 (29.5%) postmenopausal women. Many patients had atherosclerotic risk factors. Typical angina and atypical chest pain were reported by 63 (60%) and 42 (40%) patients, respectively. ECG was normal in 46 (43.8%) and abnormal in 59 (56.2%) patients. The most common abnormal finding in ECG was ST-T changes seen in 49 (46.7%) patients. Regional wall motion abnormality with mild left ventricular systolic dysfunction was seen in 4 (3.8%) patients while 101 (96.2%) patients had normal ventricular function in echocardiography. TMT was positive for inducible ischemia in 35 (33.3%) patients and inconclusive in 10 (9.5%) patients. Angiography showed normal epicardial coronaries in 85 (80.9%) patients. Conclusions: Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of them have atherosclerotic risk factors but their presentation is different from those with obstructive coronaries.

Cardiac Syndrome X (CSX) was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL). According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA).Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels) has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme) on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency –> increase in self-belief), and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients.

Objective: Cardiac Syndrome X (CSX) can be defined as having chest pain with angina in patients with normal coronary arteries. Endothelial and microvascular dysfunction is responsible from pathophysiology of the inflammatory CSX disease. Inflammation is an important factor for progression of especially ischemic heart diseases. It is accepted that both number of B and T lymphocytes and expression of various proinflammatory cytokines that are released from those cells increase during inflammatory response. Different proinflammatory cytokines are produced by activated mcrophages and T lymphocytes. Since interleukin-17 (IL-17) induces many signaling molecules, which promote immune response and have role in inflammation, it is assumed that IL-17 can play a role in pathogenesis of CSX. In our study, the relation of CSX with IL-17 serum levels and - 152G/A polymorphism on IL-17 gene was investigated. Methods: Serum IL-17 levels of blood samples from 100 CSX patients and 101 healthy control individuals by using ELISA method. After DNA isolation was performed from blood samples, IL-17 gene -152G/A polymorphisms were detected based on PCR-RFLP method for both patients and healthy individuals. Promotor region of IL-17 gene was amplified by PCR method and then, genotyping was performed by using PCR products for RFLP step. After that, obtained data for CSX patients and healthy control group were compared by statistical analysis. Results: When IL-17 gene -152G/A polymorphism genotyping results of CSX patients and healthy control individuals were compared, no statistically significant difference was observed in both genotypic and allelic distributions (p=0.218). IL-17 serum levels were found as statistically significantly higher in CSX patients than healthy controls (p<0.001). Conclusion: Endothelium has significant role in regulation of vascular functions. Inflammatory response is generated against endothelial activation in the pathogenesis of CSX. Increase in CRP levels, which is a marker of inflammation, is a common for both coronary artery disease and CSX, associated with endothelial dysfunction. Helper T cells take important parts in cardiovascular diseases. IL-17 induces expression of different proinflammatory cytokines and chemokines, participating in tissue infiltration and destruction. There are also several studies that prove the significant role of proinflammatory IL-17, which is released from T cells, in cardiovascular diseases, supporting our results. Besides, it has been demonstrated that statins, having anti-inflammatory effects, inhibit IL-17 gene expression and cytokine release. In this context, we foresee that statins can have a subsidiary effect on CSX treatment to suppress inflammatory response in patients, of which IL-17 levels were determined as significantly higher than healthy controls. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cardiac syndrome X (CSX) is often described as angina or angina-like chest pain with a normal coronary arteriogram, yet the underlying pathophysiological mechanisms have not been fully elucidated. The aim of the current study was to determine alterations in blood rheology (erythrocyte aggregation and deformability, plasma viscosity - PV) in patients with CSX. Methods: The study comprised 26 CSX patients (55.77 ± 12.33 years) and 37 age- and sex-matched (56.32 ± 11.98 years) healthy controls. Erythrocyte aggregation and deformability were measured by an ektacytometer and PV with a rotational viscometer. Results: Erythrocyte deformability measured at 1.69 and 3.00 Pa was lower in the CSX patients compared to the controls (p = .0001 and.017, respectively). Erythrocyte aggregation index (AI) (72.758 ± 7.65 vs. 66.483 ± 6.63, p = .002) and PV measured at a shear rate of 375 s−1 (1.932 ± 0.225 vs. 1.725 ± 0.331, p = .019) were significantly higher in patients with CSX. When AI, RDW and erythrocyte deformability measured at 1.69 Pa were evaluated together, it was observed that the increase in AI and RDW augments the risk of having CSX (OR: 1.2 and 2.65, respectively), while the rise in deformability decreases this risk (OR = 0.02). Conclusions: Hemorheological impairments are associated with CSX. [ABSTRACT FROM AUTHOR]